Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Tuesday, August 12, 2008

Human Subjects Research

As I said yesterday, if a race of technologically superior extraterrestrials had wanted to test our scientific talents, they couldn't have come up with a better experiment than starting the HIV pandemic. HIV has taught us a lot about the immune system and about viruses, but we still haven't come up with a way to prevent or cure it.

It's also been an extremely revealing sociological experiment. As everybody knows, it was first noticed among gay men in the United States. For many years, it was absolutely devastating -- men have told me heartbreaking tales of seeing their networks of friends almost entirely wiped out by a brutal, lingering form of disability and death. But it also had a galvanizing effect on gay activism and community organization, and it is fair to say that the epidemic converted thousands of gay men into activists, who stepped out of the shadows to demand, first of all, an adequate investment in HIV-related research and treatment, and ultimately created the modern gay rights movement which is transforming U.S. society and inspiring change around the world.

Don't get me wrong, though -- the initial response to the AIDS epidemic in the society as a whole was intensified discrimination and homophobia, and that hasn't gone away either. The essential problem of the public health response to HIV when it was still perceived as the Gay Plague was to combat stigma and discrimination. And then it was noticed that HIV existed among another marginalized group, injection drug users, and finally that it was an affliction of poor people generally in the poorest countries, initially principally in Africa and Haiti, and that it was showing up among men who have sex with men, female sex workers, and injection drug users all over the planet. And of course it doesn't stop there -- it passes to the babies of infected women, and to the female partners of infected men (less likely in the other direction, which is a less likely situation in the first place), particularly in cultures in which they have no way of protecting themselves.

So the ETs have given us an incurable disease which preferentially seeks out the wretched and despised. How we respond to this situation is an exacting test of our moral nature as a species. One thing it has taught me already is that religious leaders -- the people who claim official standing as proponents and judges of morality -- are for the most part notably immoral. The Catholic hierarchy and the evangelical leaders who campaign for "moral values" are the most egregious offenders. Their beliefs are the precise opposite of moral beliefs, and are radically offensive to the Jesus of the Gospels.

It has also taught me that there is, after all, a great reservoir of moral commitment among humans, and that the ethical basis of medicine and public health is sound. Impressive moral leadership has come from within the medical profession, from the schools of public health, and from ordinary people from all over the world who have dedicated their lives to fighting the HIV pandemic -- and that means standing forcefully against "morality," as understood by the preachers, and standing up for human dignity, human rights, and the worth of every individual. In other words, some good may come of this.